Assessing predictors of brachytherapy utilization among cervical cancer patients in Nigeria: evidence from a tertiary cancer centre

Abstract

BACKGROUND: Brachytherapy is required for curative management of cervical cancer, but it is resource-intensive and technically challenging. There is limited data describing brachytherapy utilisation and its predictive factors influencing it in low- and middle-income countries, including Nigeria. This study assessed the trend of brachytherapy utilisation and its predictors among cervical cancer patients in Nigeria. METHODS: We conducted a retrospective study of patients treated for cervical cancer (stage I-IVA) at Medserve-LUTH Cancer Centre between March 2021 and June 2024. Sociodemographic, clinical, and disease-related variables were summarized using descriptive statistics. Univariable and multivariable logistic regression models were used to identify predictors of brachytherapy utilization. RESULTS: Among the 343 patients, average age was 57.82 ± 11.77 years, 242 (70.55%) had stage II or III disease, and 173 (50.43%) received brachytherapy. Age, religion, disease stage, employment status, abdominopelvic pain at presentation, treatment delay, and menopausal state were significantly associated with brachytherapy utilization on univariable analysis (all p < 0.05). Women with increasing age, advanced disease, abdominopelvic pain at presentation, longer treatment delay, and who were Muslims had lower odds of brachytherapy utilization, while employed or premenopausal women had higher odds. On multivariable logistic regression, increasing age (p = 0.005, OR = 0.953, 95% CI = 0.921-0.986), religion (p = 0.003, OR = 0.346, 95% CI = 0.171-0.701), and treatment delay (p = 0.037, OR = 0.929, 95% CI = 0.868-0.996) remained independent predictors of lower brachytherapy utilization. CONCLUSION: This study shows disparities in brachytherapy utilization and suggests that religious beliefs and treatment delay limit access to curative treatment. These disparities may be addressed by intensifying education about early screening, early presentation, and adherence to treatment, especially in religious settings and among religious leaders. However, further studies need to be carried out on a larger population.